More on “Days” by Larkin
From Letters to Monica
Last month comparison with Amis (click here), yesterday two French versions (click here), today Larkin’s own self-deprecating comments. Days deserves them all.
5 August 1953
[...] I’ve written a tiny little poem since returning, hardly a poem at all:
What are days for?
Days are where we live.
They come, they wake us
Time and time over.
They are to be happy in:
Where can we live but days?
And to seek where they join*
Brings the priest and the doctor
In their long coats
Running over the fields.
(*Line later revised to: Ah, solving that question)
Don’t take it seriously, but it’s a change from the old style.
Wednesday I shouldn’t think there’s much danger of yr taking it seriously having just re-read it, but I can’t rub it out. [...]
21 November 1971
Did I tell you about my discovery in Larkin studies? I was rereading The Wind in the Willows, & found within a few pages of each other ‘long coats’ and ‘running’ and ‘over the fields’. Isn’t that odd? It’s where Toad crashes the car and is chased. I’m sure I got the words from there – hiding places thirty years deep, at least. But perhaps I’ve told you before – perhaps I’ve realised it before. Brain going. Pox got. [...]
He’s referring to chapter 10 of TWITW by Kenneth Grahame, The Further Adventure of Toad. Monica had given him an expensive illustrated edition for Christmas 1950, but he had loved the book as a child, as his letter to her (28 December 1950) makes clear.
Days by Philip Larkin – in French
I don’t know who did this translation, but I like it.
À quoi servant les journées?
À être le séjour de notre vie.
Elles viennent, elles nous réveillent
Tant et tant de fois.
Il faudra que du bonheur s’e loge.
Ou vivre, sinon dans les journées?
Régler la question fera
Surgir prêtre et docteur
Dans leurs longs manteaux courant
Par-dessus les champs.
Here’s another translation. I like this one too.
Pour quoi sont-ils les jours?
Les jours sont où nous vivons.
Ils viennent, ils nous réveillent
temps et temps plus de.
Ils doivent être heureux dans:
Où pouvons-nous habiter mais les jours?
Ampèreheure, résolvant que la question
apporte le prêtre et le docteur
dans des leurs longs manteaux fonctionnant
au-dessus des champs.
And here is the original.
What are days for?
Days are where we live.
They come, they wake us
Time and time over.
They are to be happy in:
Where can we live but days?
Ah, solving that question
Brings the priest and the doctor
In their long coats
Running over the fields.
Is surviving translation a sign of greatness?
River Welland
Market Deeping to Spalding
The Welland can be canoed above Stamford (click here) but it’s not easy, and even below there are many weirs and other obstructions. We started below Deeping St James High Lock, leaving only one portage before Spalding. Camping at Crowland breaks up the open fenland section.
0 miles – Deeping St James High Lock. The locals recommend parking on the roadside away from the river, but who wants to get run over? We faced them down.
0.25 miles – B 1162 bridge, followed by footbridge. The dog, first trip in a canoe, is just about to learn you can’t walk on water.
0.5 miles – Deeping St James Priory Church left
1 mile – Deeping St James. Low lock and weir. Portage over the island.
Old lock chamber still visible in R channel
1.6 miles – railway bridge. Looks a bit rusty, but carries the Spalding to Peterborough line.
1.8 miles – Maxey cut joins right, followed by Car Dyke.
The river changes character. From here to Spalding it’s wide, straight and deep, with high banks – no fun in a headwind.
2 miles – Gravel bank left. Access to the bird sanctuary.
River bend at 4 miles. Soon Crowland water tower comes into view.
5 miles – B1166 bridge. Crowland 1/2 mile right.
Access left, camping (click here) and Ye Olde Bridge Inn. The day we visited, May 2013, the manager had just run off with the takings and the pub was closed. The campsite had trouble with the loos, so we had to use the ones in a static caravan. But the sun shone and everyone was friendly. A great spot.
The Abbey is visible from the river. So are Crowland Cranes. This may be rural, but it’s not tourist country. Unlike the Lake District or Pennines, where they live off cream teas and EU subsidy, Lincolnshire farmers are the real deal, filling containers with produce for our supermarkets. Unused corners get crane companies on them! Crowland recently entered into partnership with Zoomlion Heavy Industry, one of the world’s largest manufacturers. The Chinese are coming.
7 miles – Four Mile Bar footbridge
8.5 miles – A16 bridge
9.5 miles – New river joins right
9.6 miles B1172 bridge
9.8 miles – disused railway bridge
Coronation Channel leaves right.
The Coronation channel was built to stop Spalding flooding, and by all accounts is doing a good job. It’s not a navigation. The Spalding river taxi is the only powered boat allowed to use it.
But it’s canoeable up to the sluice gates where it rejoins the tidal river. A circular tour requires a portage.
Main river10 miles – footbridge
10.2 miles – footbridge
10.3 miles footbridge 10.5 miles footbridge. Road bridge B1172
10.7 miles footbridge 10.9 miles – two footbridges 11.2 miles – A151 bridges
11.4 miles – Lock
The third reverse gate facing downstream holds back high tides.
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Coronation channel10 miles – Leaves river right under road bridge
10.5 miles – bridge
10.75 miles – bridge
11 miles – bridge
11 .25 bmiles – bridge disused
11.5 miles – railway bridge disused
Road bridge A151 bridge Bridge and sluice gates
Land left just above the barrier buoys for portage back to the Welland
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11.6 miles – Coronation channel rejoins the now tidal river right.
The tidal river does not look attractive canoeing.
Jim Thornton
Nocturne
By Kingsley Amis
First published in The Fantasy Poets No 22, 1954, and later included in Amis’s first mature collection, A Case of Samples 1956, a year after Larkin’s The Less Deceived, this hardly matches Wedding Wind, Church Going or At Grass, but it’s pretty good.
I like Amis’s humour; on this the Watch Committee/And myself seem likely to agree. And not only using drunks and lusty couples to show up our differences from animals, but doing so in a serious and moving way – Larkin would have approved.
Under the winter street lamps, near the bus-stop,
Two people with nowhere to go fondle each other,
Writhe slowly in the entrance to a shop.
In the intervals of watching them, a sailor
Yaws about with empty beer-flagon,
Looking for something good to smash it on.
Mere animals: on this the Watch Committee
And myself seem likely to agree;
But all this fumbling about, this wasteful
Voiding of sweat and breath – is that animal?
Nothing so sure and economical.
These keep the image of another creature
In crippled versions, cocky, drab and stewed;
What beast holds off its paw to gesture,
Or gropes towards being understood?
Dis-Harmoni in Hackney
Competing for out-of-hours care
Critics of the health reforms who accuse the private sector of cherry picking sometimes have a point, but not for primary care out-of-hours calls.
Time was when no-one wanted to do them. Old style general practitioners had to, it was in the contract, but they were a pain, so they set up rotas, and especially in big cities switched over to a ragbag of commercial Doctors Deputising Services (DDS) to fill the gaps. These outfits were often staffed by doctors who couldn’t get jobs elsewhere, or who were moonlighting and tired – the Dangerous Doctors Service – so it was frowned on to use them too much, and they had to be paid out of practice funds, so complicated and inefficient systems grew up with practices switching over at different times. Patients sometimes got through directly to a doctor, sometimes a dispatcher, but they rarely got to see their own GP.
Then in 2004 GPs negotiated a new contract with the Department of Health allowing them to opt out of 24-hour care altogether. Nearly all, 90%, did so, and the Primary Care Trusts, who ran things back then, had to find someone else to do the work. In Hackney the PCT chose Harmoni, one of the best of the old deputising services. Harmoni had started out in 1996, as a GP cooperative in nearby Harrow, and the new GP contract allowed it to expand. In 2005 venture capital was bought in and a whole network of phone banks, 24-hour surgeries, and doctors and drivers set up. It is now the county’s largest provider of out-of-hours care. All calls are triaged by a nurse, and their contract insists that they keep data on response times, visit and referral rates, and clinical incidents. By all accounts they make a decent profit.
Although patients still rarely if ever see their own GP, it’s probably an improvement. Harmoni faces losing the contract if it performs badly, the opposite of the old system where the GPs didn’t want to do it, but couldn’t avoid it! But it’s tricky to prove, because the old system didn’t keep the same records, times have changed, and patients behaviour and expectations are different.
Then a funny thing happened. The Hackney GPs saw how profitable out of hours care could be, and set up a new co-operative, City and Hackney Urgent Healthcare Social Enterprise (CHUHSE) to win the contract back! You might think they wouldn’t stand a chance, but they have some good cards to play. Where night call problems used to be smoothed over as quickly as possible, now they’re ammunition for the cause. Patient groups pop up, and articles alleging poor standards by Harmoni appear in The Guardian (click here and here).
CHUHSE‘s first bid last summer failed, allegedly because the PCT was nervous about allocating the contract to a new provider without proper tendering, just before handing over to the new Clinical Commissioning Groups. That’s one of the points of the new system – to make it more difficult for local GPs to allocate contracts to their mates. CHUHSE is grumbling, and alleging that they were knocked back for political reasons.
But patients should be delighted. Two organisations are competing hard to provide an unpopular service, and the people who know best, the local GP-led Clinical Commissioning Groups will decide after a proper procurement process.
Jim Thornton
More KEEPS confusion
I was off target this morning (click here), wondering why an open sub-study paper had appeared before the main KEEPS trial results. But not in a good way.
The KEEPS main trial has still not appeared in a peer-reviewed journal. No raw data or clinical endpoints have been published anywhere, not even the raw data for the primary endpoint, carotid intimal medial thickness (CIMT) at four years.
But since October 3rd 2102, press releases, websites, interviews with health journalists, and at least one conference presentation have leaked out the authors’ conclusions. These were always positive. Here are a couple of examples:
“researchers concluded that estrogen/progesterone treatment started soon after menopause appears to be safe; relieves many of the symptoms of menopause; and improves mood, bone density, and several markers of cardiovascular risk.” Here
“Hormone Therapy Has Many Favorable Effects in Newly Menopausal Women: Initial Findings of the Kronos Early Estrogen Prevention Study (KEEPS)” and “Estrogen /progesterone treatment started soon after menopause appears safe and relieves many of the symptoms menopausal women face as well as improving mood and markers of cardiovascular risk, according to a multicenter randomized study” Here
Google “KEEPS HRT” to find dozens more. But read the details. This is from the North American Menopause Society meeting abstract (click here).
“The carotid ultrasound studies showed similar rates of progression of arterial wall thickness in all three treatment groups over the four years of study. These changes were generally small, limiting the statistical power to detect any differences among the groups.”
i.e. the trial was negative. Neither estrogen nor estrogen & progestagen improved CIMT, the chosen surrogate marker for cardiovascular disease. But anyone who had not checked the trial registration site for the primary outcome would never realise this.
It’s difficult to criticise this sort of thing properly until the full trial report is published. But this looks like drug marketing masquerading as research.
The KEEPS study itself is funded by grants from the Auroroa Foundation, an outfit largely funded by the billionaire John Spurling. The study drugs were supplied by Bayer Health Care and Abbott Pharmaceuticals. The KEEPS chief investigator Howard R Hodis does not list any conflicts in his papers but has appeared on HRT marketing videos sponsored by Wyeth (click here). Another Rogerio Lobo is on my name and shame list (click here).
Look out for the trial report.
Jim Thornton
KEEPS Confusing
The Kronos Early Estrogen Prevention Study (KEEPS click here)
Why would a randomised double-blind trial, which completed recruitment in June 2008 and whose participants presumably reached the final primary outcome at four years in June 2012, suddenly publish an unblinded substudy before the main trial report? KEEPS did this in February (click here).
Were Mayo clinic participants unblinded just so that the effect of estrogen on bone density could be reported? That’s hardly a major discovery. Is KEEPS really double blind? Are centres able to break the blinding when they want to?
I’m sorry to be suspicious but KEEPS was designed to test the timing hypothesis for the effect of estrogen on cardiovascular diseases, i.e. the idea that it is cardioprotective for women within 10 years of the menopause, despite being clearly harmful later. Its authors are well known advocates of the timing hypothesis and many have received grants and lecture fees from companies marketing HRT. If they show a favourable effect of HRT on surrogate markers of cardiovascular disease they will surely trumpet it from the rooftops. Sceptics will want to be confident that those markers were measured blind.
Note for those readers who think they have already read the KEEPS results. You have, many times. Here are some KEEPS publications:
http://www.ncbi.nlm.nih.gov/pubmed/22587616
http://www.ncbi.nlm.nih.gov/pubmed/23408873
http://www.fertstert.org/article/S0015-0282(12)02492-2/abstract
http://physiolgenomics.physiology.org/content/45/2/79.long
http://www.atherosclerosis-journal.com/article/S0021-9150(11)01149-X/abstract
http://www.fertstert.org/article/S0015-0282(10)02586-0/abstract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721728/
But as far as I’m aware all these were observational studies on the whole cohort.
Jim Thornton
